Provider Demographics
NPI:1346221587
Name:MERVIS, ROBERT PAUL (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:MERVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:1201 RIVER VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1653
Practice Address - Country:US
Practice Address - Phone:740-687-2273
Practice Address - Fax:740-687-9059
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003864207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0588814Medicaid
OH0588814Medicaid
OHA16055Medicare UPIN
OH35003864OtherOHIO LICENSE